OCN ONS Bundle > Reproductive System Cancers > Flashcards

Reproductive System Cancers Flashcards

(56 cards)

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1
Q

Reproductive System Cancers (4)

A

Cervical
Endometrial
Ovarian
Testicular

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2
Q

Cervical Cancer

Risk Factors

A
  • HPV
  • Multiple sexual partners
  • Cigarettes
  • Early age first intercourse
  • Immunosuppression
  • Hx of STD’s
  • Long term contraceptives & HPV
  • Age
  • Unavailability/lack of screening
  • Multiple live births
  • Exposure to Diethylstilbestrol in utero
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3
Q

Cervical Cancer

Prevention

A
  • Limit sexual partners
  • Limit sexual encounters in teenage years
  • Use of barrier contraceptives
  • Education on safe sex practices
  • HPV Vaccination for girls 11-12 yrs
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4
Q

Cervical Cancer

Screening

A

Pap smear +

HPV dna test

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5
Q

ACS Cervical Ca Screening recommendations

1) 21-29 yrs
2) 30-65 yrs
3) 66> yrs
4) Women w total hysterectomy

A

1) Pap smear every 3 yrs
2) HPV DNA test every 5 years or Pap every 3 years
3) Cease screening/ 3 or more consec - Pap/2 or more cons Pap and HPV test within last 5 yrs
- No screening needed

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6
Q

Cervical Ca

Common S/S

A
  • Irregular bleeding (btwn menstrual periods or postcoital)
  • Persistant vaginal discharge (blood-tinged or malodorous)
  • Dyspareunia (pain during any penetration)

(not uncommon to present completely asymptomatic)

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7
Q

Cervical Ca

Late S/S

A
  • Pelvic pain often radiating to legs
  • Incontinence
  • Weight loss
  • Fatigue
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8
Q

Cervical Ca

Diagnostic tests

A
  • Pelvic exam
  • Cervical cytology
  • Endocervical curettage
  • Colposcopy
  • HPV test
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9
Q

Cervical Ca

Staging

A
  • PET scan
  • CT scan
  • Cytoscopy
  • Chest radiograph
  • US/MRI
  • Laparoscopy
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10
Q

_____ Staging method used for Cervical Cancer

A

FIGO (International Federation of Gynecology and Obstetrics)

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11
Q

Figo Stages

1
1A1
1A2

A
  • Carcinoma strictly confined to cervix
  • Stromal invasion - 3mm deep - 7mm wide
  • Stromal invasion 3-5mm deep - 7mm wide
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12
Q

Figo Stages

1B
1B1
1B1

A
  • Clinical lesions confined to cervix or preclinical lesions > than stage 1A
  • Lesions - 4cm
  • Lesions >4cm
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13
Q

Figo Stages

II
III
IV

A
  • Carcinoma beyond uterus but not on pelvic wall or lower third of vagina
  • Carcinoma onto pelvic sidewall and lower third of vagina
  • Into bladder/rectum/ other organs/mets
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14
Q

Cervical Ca

Tx

1) Early stage
2) Invasive disease
3) Advanced disease
4) Metatastic, Persistent, or Recurrent disease

A

1) Definitive Surgery
2) Combo Rt + Chemo
3) Chemo alone
4) Targeted therapy + Chemo

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15
Q

Cervical Ca surgical standard or care =

A

Radical Hysterectomy

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16
Q

Cervical Ca tx for Nonsurgical candidates

A
  • Intracavitary Rt for early stage

- Brachytherapy + Pelvic RT + Platinum based chemo for advanced stages

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17
Q

Cervical Ca common metastatic sites

A
  • Lungs
  • Para-aortic LN
  • Bones
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18
Q

Chemo for Cervical Ca

A

Fluorouracil +/- Mitomycin

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19
Q

Most common Gynecologic Ca in women in US

A

Endometrial

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20
Q

Endometrial Ca

Risk Factors

A
  • HTN
  • DM
  • Obesity
  • Increased estrogen exposure
  • Tamoxifen
  • Metabolic Snydrome
  • Nulliparity
  • Polycystic ovarian syndrome
  • Endometrial hyperplasia
  • Fam hx
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21
Q

Endometrial Ca

Poor prognosis =
Favorable prognosis =

A

= Overexpression of HER/neu gene

= high lvls of progesterone

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22
Q

Endometrial Ca

Prevention (6)

A
  • Oral contraceptives
  • Cigarette smoking (although not favorable)
  • Pregnancy (bc of high progesterone lvls)
  • Use of intrauterine devices
  • breastfeeding
  • Avoid high fat diets
  • Increase physical activity
  • Control HTN/DM
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23
Q

Best Screening Test for endometrial ca

Study These Flashcards
A

Biopsy - Endometrial sampling

pap only detets occasionally and unreliably

24
Q

Hallmark symptom of Endometrial Ca*

Study These Flashcards
A

Irregular vaginal bleeding

25
Endometrial Ca Late Sx asctd with ?
Pattern of mets
26
Endometrial Ca common sites of metastasis
Pelvic + Para-aortic LN
27
Common distant metastatic sites of Endometrial Ca
``` Lungs Liver Bones Brain Vagina ```
28
Endometrial Ca Staging systems (2)
FIGO | TNM
29
Endometrial Ca Tx for Stage 1 & 2
- Surgery w/w LN sampling - Postoperative vaginal brachytherapy - RT alone - Surgery w Postop chemo w/w RT for grade 3
30
Endometrial Ca Tx for Stage 3, 4, Recurrent
- Surgery followed by chemo or RT - Inoperable disease = Chemo + RT, Hormone or biologic therapy - Paclitaxel, Doxorubicin, Cisplatin - Clinical trials/combo therapy
31
Common Chemotherapies used for Endometrial CA (3)
Paclitaxel Doxorubicin Cisplatin
32
Ovarian Ca Risk Factors Which is most important?
- First degree relative w history of ovarian ca** (most important/BRCA12 mutations) - Family hx of breast ca - Endometriosis - Nulliparity - Use of talc - Jewish descent - Pelvic inflammatory disease - Lynch syndrome - Use of postmenopausal hormone therapy - Obesity and tall height
33
Ovarian Ca Prognostic indicators
- Younger age - lower stage at dx with well differentiated tumor - lower tumor burden - lack of ascites at dx - low residual disease following surgery - serum cancer associated antigen (CA-125) - no relevance at time of dx but correlates with survival following chemo
34
Ovarian Ca - Usually has _____ sx and diagnosed in ____ stage disease
vague | late
35
Ovarian Ca Preventative measures
- Pregnancy - Lactation - Oophorectomy prophylactic - Tubal ligation - Use of oral contraceptives - Annual health exam including bimanual rectovaginal exam
36
Ovarian Ca Screening?
Not really available bc of anatomical position of ovaries, deep in pelvis
37
Ovarian Ca Symptoms (4) vague
- Pelvic mass - Abdominal pain (similar to appendicitis) - Distention, bloating, constipation - Vaginal bleeding
38
Ovarian Ca GI symptoms
- Bloating - Dyspepsia - Early satiety - Nausea - Urinary symptoms - Constipation - Diarrhea - Back pain - Fatigue
39
Ovarian Ca Gynecologic symptoms
- Abdominal distention/girth (caused by tumor or ascites) - Pelvic pain - Menstrual irregularities - Vaginal bleeding - Watery vaginal discharge
40
Ovarian Ca Diagnostic tests Definitive diagnosis?
- Pelvic examination including bimanual rectovaginal exam to palpate ovaries - US if mass is suspected - CT scan - PET scan - C-Xray - MRI - Serum CA-125 assay Biopsy and microscopic examination of tissue
41
Ovarian CA Stage 1 Stage 2 Stage 3 Stage 4
1) Tumor confined to ovaries or fallopian tubes 2) Extension into below pelvic brim or peritoneal cancer 3) Spread to peritoneum outside of pelvis and/or metastasis to retroperitoneal lymph nodes 4) Distant metastasis excluding peritoneal mets
42
Ovarian Ca Early Stage Tx 1) 3 ectomy's + ____ sampling + ____inspection and _____ of adjacent organs: peritoneal ____ followed by 2) Systemic _____ (____ based), intra____ chemo, or chemo with ____umab 3) _____ chemo followed by surgery
``` 1) Hysterectomy Oophorectomy Omenectomy lymph node visual biopsy washings ``` 2) chemo (platinum) peritoneal bevacizumab 3) neoadjuvant
43
Ovarian Ca Advanced Stage disease tx
- Neoadjuvant chemo - Hysterectomy, bilateral salpingo oophorectomy, omentectomy + debulking - Intraperitoneal adjuvant chemo - Adjuvant systemic chemo - Clinical trials
44
Ovarian Ca Recurrent Disease Tx - _____ containing chemo - (3)
- Platinum | - Bevacizumab, PARP inhibitors (targeted therapy), other targeted therapy w/w chemo
45
Ovarian Ca Advanced disease palliative surgeries (4)
- Gastrostomy tube insertion - Indwelling peritoneal catheter - Pleural catheter - Intestinal stenting
46
Testicular Ca Prevention
Surgical repair of cryptorchidism prior to puberty Crypto: when testes fail to descend from abdomen into scrotum
47
Testicular Ca Risk Factors (3)
- Prior hx of testicular ca - Cryptochidism - Family hx
48
- 98% of Testicular Cancers histologically are - Primarily dx in men ages __-__yrs - Treatable/curable?
Germ cell tumors - 15-35 - Highly treatable and curable
49
Testicular Ca Favorable Prognostic Factors - ___ stage and extent of disease at dx - Low serum markers (3)
- Low | - Alpha fetoprotein (AFP), Lactase dehydrogenase (LDH), Beta-human chorionic gonadotropin (beta-hCG)
50
Testicular Ca Symptoms
- Pea like, hard, painless swelling or enlargement of testis - If pain is present, typically asctd w local hemorrhage within tumor - Achiness in testis - Heaviness in scrotum - Dull low backache - Asymmetry
51
Testicular Ca Hormonal Symptoms (2)
- Breast tenderness or growth | - Loss of or reduced libido
52
Testicular Ca Metastatic Symptoms (3)
- Back or chest pain - Coughing - SOB, hemoptysis
53
Testicular Ca Diagnostic tests (2) What is the imaging of choice?
- Physical exam, family hx Ultrasound
54
Testicular Cancer Seminoma vs Nonseminoma
Both are germ cell tumors, cells that make sperm Seminoma: slower growing found in men in their 40-50's, can spread to LN, very sensitive to RT Nonseminoma: more common, grows more quickly
55
Testicular Ca Tx for Low Grade Seminoma (less common, in men 40-50) = Radical inguinal ____ + (3)
Orchiectomy + - surveillance - RT - 1 or 2 doses of adjuvant carboplatin
56
Testicular Ca Tx for Low Grade Nonseminoma (more common, grows more quickly than seminoma) = Radical inguinal _____ + (3)
Orchiectomy - surveillance - nerve-sparing retroperitoneal LN dissection - Adjuvant bleomycin, etoposide, cisplatin (BEP)
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